Ethical Questions in Medical Electronic Adherence Monitoring

Campbell, Jeffrey I.; Eyal, Nir; Musiimenta, Angella; Haberer, Jessica

doi:10.1007/s11606-015-3502-4

Cited by 49 publications

(39 citation statements)

References 28 publications

(30 reference statements)

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“…This study also highlights the importance of clinician access to objectively measured adherence data to inform discussions about adherence since time and date stamped data enable respondents to identify beliefs and experiences related to specific instances of documented behaviour. Concerns are often expressed about the use of objective adherence data within consultations because of fears of ‘big brother watching’ (Campbell, Eyal, Musiimenta, & Haberer, ); however, participants in this study were aware that health professionals were monitoring their adherence as part of their care and were positive about the role that this played in helping them to understand and support their adherence.…”

Section: Discussionmentioning

confidence: 87%

Adherence to medication in adults with Cystic Fibrosis: An investigation using objective adherence data and the Theoretical Domains Framework

Arden

Drabble

O’Cathain

et al. 2019

British J Health Psychol

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Objectives Adherence to nebulizer treatment in adults with Cystic Fibrosis ( CF ) is poor, and interventions are needed. This research aimed to identify the factors affecting nebulizer adherence using the Theoretical Domains Framework (TDF) and to compare these for participants with different levels of adherence. Design Data‐prompted interviews using the TDF. Methods Eighteen semi‐structured interviews were conducted with adults with CF during which objectively measured adherence data were discussed. Framework analysis was used to code the data into TDF domains, and inductive qualitative content analysis was used to code different beliefs and experiences. Aspects of the TDF that differed between participants with different adherence levels were explored. Results Factors influencing adherence to treatment included all 14 domains of the TDF , 10 of which appeared to vary by adherence level: Skills; Memory and decision‐making; and Behavioural regulation; Environmental context and resources; Social influences; Beliefs about consequences; Beliefs about capability; Reinforcement; Social role and identify; Intentions; Optimism; and Emotions. Conclusions This study is the first to use objectively measured adherence data in a data‐prompted interview using the TDF framework to systematically assess the full range of factors potentially influencing adherence. The results highlighted that interventions need to consider issues of capability, opportunity, and motivation. Interventions that challenge dysfunctional beliefs about adherence and which support the development of routines or habits and problem‐solving may be particularly useful for adults with CF . Statement of contribution What is already known? Adherence to medication in adults with cystic fibrosis is poor. Previous research has identified a range of contributing factors in relation to subjective reports of adherence. There is a wide discrepancy between self‐reported adherence and objectively measured adherence. What this study adds A data‐prompted interview using objectively measured adherence data enabled the systematic assessment of potential factors that could be targeted in an intervention to increase adherence. There were some differences in the factors that were identified by high and low adherers. There is not one‐size fits all intervention for adherence to medication in cystic fibrosis.

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Section: Discussionmentioning

confidence: 87%

Adherence to medication in adults with Cystic Fibrosis: An investigation using objective adherence data and the Theoretical Domains Framework

Arden

Drabble

O’Cathain

et al. 2019

British J Health Psychol

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“…However, RTAM devices have been shown to predict outcomes that are dependent on drug intake, such as viral suppression[100, 101]. In terms of acceptability, RTAM has been well accepted in research studies overall[102, 103], although some concerns about the privacy, autonomy, confidentiality and/or stigma associated to RTAMs have emerged, in particular in mobile populations who may have difficulty traveling with the device, as well as those who feel marginalized[104, 105]. In addition, because these devices usually depend on a reliable network, the risk for technological failure remains tangible, in particular in areas with intermittent cellular coverage[100, 103, 106].…”

Section: Measures Of Adherence That Can Lead To Actionable Interventionsmentioning

confidence: 99%

Adherence Measurements in HIV: New Advancements in Pharmacologic Methods and Real-Time Monitoring

2018

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Antiretroviral drug concentrations in hair and dried blood spots are two novel pharmacological measures of cumulative drug adherence and exposure that have been recently evaluated in HIV treatment and pre-exposure prophylaxis. Real-time adherence monitoring using electronic devices has also proven highly informative, feasible, and well accepted, offering the possibility for an immediate intervention when non-adherence is detected. Both approaches offer considerable advantages over traditional adherence measures in predicting efficacy. New methods to objectively monitor adherence in real-time and over long time periods have been developed. Further research is required to better understand how these measures can optimize adherence and, ultimately, improve clinical outcomes in HIV treatment and prevention.

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“…In these instances, the intervention could not function as planned because participants opted to take medication from different sources other than the monitor. These participants worried about stigma and discrimination associated with unintended HIV status disclosure, as has been seen previously in China [2,22]. Youth also reported concerns of HIV status disclosure resulting from other people accessing SMS reminders in another study in Kampala, Uganda [6].…”

Section: Discussionmentioning

confidence: 54%

Acceptability and Feasibility of Real-Time Antiretroviral Therapy Adherence Interventions in Rural Uganda: Mixed-Method Pilot Randomized Controlled Trial (Preprint)

Musiimenta¹,

Atukunda²,

Tumuhimbise³

et al. 2017

Preprint

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BACKGROUND Wireless electronic adherence monitors can detect antiretroviral therapy (ART) adherence lapses and trigger interventions in real time, thus potentially avoiding unnecessary HIV viremia. Evidence about the acceptability and feasibility of these monitors and associated interventions, however, is limited. OBJECTIVE The aim of this study was to assess the acceptability and feasibility of real-time adherence monitoring linked to text messaging (short message service, SMS) reminders and notifications to support adherence among individuals living with HIV who are taking ART in rural southwestern Uganda. METHODS Individuals living with HIV who were initiating ART were enrolled in a pilot randomized controlled trial and followed up for 9 months. Participants received a real-time adherence monitor and were randomized to one of the following study arms: (1) scheduled SMS, (2) SMS triggered by missed or delayed doses, or (3) no SMS. SMS notifications were also sent to 45 patient-identified social supporters for sustained adherence lapses in the scheduled SMS and triggered SMS arms. Study participants and social supporters participated in qualitative semistructured in-depth interviews on acceptability and feasibility of this technology. An inductive, content analytic approach, framed by the unified theory of acceptance and use of technology model, was used to analyze qualitative data. Quantitative feasibility data, including device functionality and SMS tracking data, were recorded based upon device metrics collected electronically and summarized descriptively. RESULTS A total of 63 participants participated in the study. Participants reported that real-time monitoring intervention linked to SMS reminders and notifications are generally acceptable; the predominant feedback was perceived utility—the intervention was beneficial in motivating and reminding patients to take medication, as well as enabling provision of social support. The intervention was found to be technically feasible, as data were obtained from most participants as expected most of the time. Potential challenges included the impact of the technology on confidentiality, shared phone ownership, usability skills, and availability of electricity. CONCLUSIONS Real-time adherence monitoring integrated with SMS reminders and social support notifications is a generally acceptable (based primarily on perceived utility) and feasible intervention in a resource-limited country. Future efforts should focus on optimized device design, user training to overcome the challenges we encountered, cost effectiveness studies, as well as studying the monitoring aspect of the device without accompanying interventions. CLINICALTRIAL ClinicalTrials.gov NCT01957865; https://clinicaltrials.gov/ct2/show/NCT01957865 (Archived by WebCite at http://www.webcitation.org/6zFiDlXDa)

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Ethical Questions in Medical Electronic Adherence Monitoring

Cited by 49 publications

References 28 publications

Adherence to medication in adults with Cystic Fibrosis: An investigation using objective adherence data and the Theoretical Domains Framework

Adherence to medication in adults with Cystic Fibrosis: An investigation using objective adherence data and the Theoretical Domains Framework

Adherence Measurements in HIV: New Advancements in Pharmacologic Methods and Real-Time Monitoring

Acceptability and Feasibility of Real-Time Antiretroviral Therapy Adherence Interventions in Rural Uganda: Mixed-Method Pilot Randomized Controlled Trial (Preprint)

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